Effectiveness of bubble continuous positive airway pressure for treatment of children aged 1-59 months with severe pneumonia and hypoxaemia in Ethiopia: a pragmatic cluster-randomised controlled trial.

BACKGROUND: The safety and efficacy of bubble continuous positive airway pressure (bCPAP) for treatment of childhood severe pneumonia outside tertiary care hospitals is uncertain. We did a cluster-randomised effectiveness trial of locally made bCPAP compared with WHO-recommended low-flow oxygen therapy in children with severe pneumonia and hypoxaemia in general hospitals in Ethiopia. METHODS: This open, cluster-randomised trial was done in 12 general (secondary) hospitals in Ethiopia. We randomly assigned six hospitals to bCPAP as first-line respiratory support for children aged 1-59 months who presented with severe pneumonia and hypoxaemia and six hospitals to standard low-flow oxygen therapy. Cluster (hospital) randomisation was stratified by availability of mechanical ventilation. All children received treatment in paediatric wards (in a dedicated corner in front of a nursing station) with a similar level of facilities (equipment for oxygen therapy and medications) and staffing (overall, one nurse per six patients and one general practitioner per 18 patients) in all hospitals. All children received additional care according to WHO guidelines, supervised by paediatricians and general practitioners. The primary outcome was treatment failure (defined as any of the following: peripheral oxygen saturation <85% at any time after at least 1 h of intervention plus signs of respiratory distress; indication for mechanical ventilation; death during hospital stay or within 72 h of leaving hospital against medical advice; or leaving hospital against medical advice during intervention). The analysis included all children enrolled in the trial. We performed both unadjusted and adjusted analyses of the primary outcome, with the latter adjusted for the stratification variable and for the design effect of cluster randomisation, as well as selected potentially confounding variables, including age. We calculated effectiveness as the relative risk (RR) of the outcomes in the bCPAP group versus low-flow oxygen group. This trial is registered with ClinicalTrial.gov, NCT03870243, and is completed. FINDINGS: From June 8, 2021, to July 27, 2022, 1240 children were enrolled (620 in hospitals allocated to bCPAP and 620 in hospitals allocated to low-flow oxygen). Cluster sizes ranged from 103 to 104 children. Five (0·8%) of 620 children in the bCPAP group had treatment failure compared with 21 (3·4%) of 620 children in the low-flow oxygen group (unadjusted RR 0·24, 95% CI 0·09-0·63, p=0·0015; adjusted RR 0·24, 0·07-0·87, p=0·030). Six children died during hospital stay, all of whom were in the low-flow oxygen group (p=0·031). No serious adverse events were attributable to bCPAP. INTERPRETATION: In Ethiopian general hospitals, introduction of locally made bCPAP, supervised by general practitioners and paediatricians, was associated with reduced risk of treatment failure and in-hospital mortality in children with severe pneumonia and hypoxaemia compared with use of standard low-flow oxygen therapy. Implementation research is required in higher mortality settings to consolidate our findings. FUNDING: SIDA Sweden and Grand Challenges Ethiopia.

Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study.

BACKGROUND: Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. METHODS: A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. FINDINGS: 27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility. INTERPRETATION: High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices. FUNDING: The Bill & Melinda Gates Foundation.

The traditional use of wild edible plants in pastoral and agro-pastoral communities of Mieso District, eastern Ethiopia.

BACKGROUND: The populations in Ethiopia have developed their indigenous knowledge to use, manage and conserve wild edible plants (WEPs). In the eastern part of Ethiopia, wild edible plants are used as a means of survival during times of food shortage and as dietary supplements. Documenting the traditional and cultural use of wild food plants is a vital step in obtaining baseline data for investigating nutritional values and possible side effects, preserving indigenous knowledge, and ultimately interesting in wild edible plant conservation. However, their significance, management and utilization have not been documented in Mieso District. Therefore, this study aimed to provide documentation of wild edible plant use associated with ethnobotanical knowledge in Mieso District, eastern Ethiopia. METHODS: An ethnobotanical study of wild edible plant species was conducted from March 2021 to May 2022. A total of 120 (72 males and 48 females) informants were selected using the snowball method. Data collection methods, including semistructured interviews, direct observation and field walks were used. Data were analysed using descriptive statistics, including independent sample t test and analysis of variance (ANOVA). We calculated use values (UVs) to analyse the relative cultural importance of each plant species. RESULTS: A total of 41 wild edible plant species belonging to 33 genera in 21 families were documented to be used as food sources both during times of food shortage and as dietary supplements. Family Malvaceae was best-represented with 6 species, followed by Fabaceae and Rhamnaceae (4 species each). The dominant growth form (habit) was shrubs (30 species), followed by trees (11 species). The most widely used plant parts were fruits (covering 39 species, 95%). The largest number (23 species) was collected from forest habitats only, followed by both village and forest habitats (8 species). The majority of wild edible plants (28 species or 68%) were consumed only during famine or in the time of food shortage followed by supplementing staple foods (9 species or 22%). Wild edible plants in Mieso are used for multiple other uses, including for fodder, fuel, medicine, construction, cosmetics and bee keeping. Twenty-three species were mentioned for fodder use, followed by fuel purpose (21 species) and medicinal value (13 species). The species that had the highest use values were Flacourtia indica (Burm.f.) Merr. (1.4), Carissa spinarum L. (1.1), Ziziphus spina-christi (L.) Desf. (0.6), Grewia villosa Willd. (0.5), Cordia monoica Roxb. (0.3) and Opuntia ficus-indica (L.) Mill. (L.) (0.2). Most WEPs were collected from March to May (Badheysa) (33 species). The highest mentioned wild edible plant sold in the market was F. indica (Burm.f.) Merr. mentioned by 20 informants, followed by Z. spina-christi (L.) Desf. (14). CONCLUSION: The people in Mieso use wild plants as supplementary food to cultivated crops, during famine, and many could be utilized for day-to-day human consumption. Some plants in the district provide cash income for local people. However, deforestation (54%), drought (22%) and agricultural expansion (12%) were the highest threats to wild plants in Mieso District. Hence, on-site and off-site conservation would help protect wild plant resources in Mieso, eastern Ethiopia.

Acute Febrile Illness Among Children in Butajira, South-Central Ethiopia During the Typhoid Fever Surveillance in Africa Program.

BACKGROUND: Clearly differentiating causes of fever is challenging where diagnostic capacities are limited, resulting in poor patient management. We investigated acute febrile illness in children aged ≤15 years enrolled at healthcare facilities in Butajira, Ethiopia, during January 2012 to January 2014 for the Typhoid Fever Surveillance in Africa Program. METHODS: Blood culture, malaria microscopy, and blood analyses followed by microbiological, biochemical, and antimicrobial susceptibility testing of isolates were performed. We applied a retrospectively developed scheme to classify children as malaria or acute respiratory, gastrointestinal or urinary tract infection, or other febrile infections and syndromes. Incidence rates per 100 000 population derived from the classification scheme and multivariate logistic regression to determine fever predictors were performed. RESULTS: We rarely observed stunting (4/513, 0.8%), underweight (1/513, 0.2%), wasting (1/513, 0.2%), and hospitalization (21/513, 4.1%) among 513 children with mild transient fever and a mean disease severity score of 12 (95% confidence interval [CI], 11-13). Blood cultures yielded 1.6% (8/513) growth of pathogenic agents; microscopy detected 13.5% (69/513) malaria with 20 611/µL blood (95% CI, 15 352-25 870) mean parasite density. Incidences were generally higher in children aged ≤5 years than >5 to ≤15 years; annual incidences in young children were 301.3 (95% CI, 269.2-337.2) for malaria and 1860.1 (95% CI, 1778.0-1946.0) for acute respiratory and 379.9 (95% CI, 343.6-420.0) for gastrointestinal tract infections. CONCLUSIONS: We could not detect the etiological agents in all febrile children. Our findings may prompt further investigations and the reconsideration of policies and frameworks for the management of acute febrile illness.